Information Technology and Management Science
doi: 10.1515/itms-2014-0019
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State of the Art in the Healthcare
Cyber-physical Systems
Alyona Skorobogatjko 1, Andrejs Romanovs 2, Nadezhda Kunicina 3, 1-3 Riga Technical University
Abstract – For several years, experts from different fields are
interested in virtual and physical world interaction opportunities.
Cyber-physical systems (CPSs) are developed to integrate real
physical processes and virtual computational processes. CPSs
are used in multiple areas such as medicine, traffic management
and security, automotive engineering, industrial and process
control, energy saving, ecological monitoring and management,
avionics and space equipment, industrial robots, technical
infrastructure management, distributed robotic systems,
protection target systems, nanotechnology and biological systems
technology. CPS sensors generate the sensitive data that must be
protected and shared only in a secure manner. This paper
provides an overview of CPSs, their application in medicine and
compliance with existing standards and possibilities for further
advanced system development.
Keywords – Embedded systems, healthcare cyber-physical
system, sensor networks.
I. INTRODUCTION
New competitive approach to the physical and virtual world
integration with cyber-physical systems (CPSs) is one of the
European Union research priorities. Cyber-physical systems
will change the way people interface with systems, the same
way as the Internet has transformed the way people interface
with information.
The aim of the current research is to develop application
strategies for cyber-physical system use in medical
organizations and telemedicine. Topicality of the theme is
based on the fact that cyber-physical systems are a promising
area, development of which is critical for medical progress.
One of the main challenges of this research is to design
strategy for CPS application to be safe, secure, resistant to
abnormalities and resilient in a variety of unforeseen and
rapidly changing environments.
There are currently no available standards for healthcare
cyber-physical systems. Therefore, it is necessary to conduct
an in-depth research to identify medical systems’ best
practices and standards, which can be applied to healthcare
cyber-physical systems.
CPS usage analysis will be performed within the framework
of the research, and CPS possible application in disease
prevention, diagnosis, treatment and patients’ rehabilitation
will be investigated. Particular attention will be paid to such
essential components as usage, architecture, sensitivity, data
management, data security and information exchange between
multiple systems. As a result, healthcare cyber-physical
system’s overall requirements will be formulated and an
application strategy will be developed.
This paper is organized as follows. In Section II, the
definition and concept of a cyber-physical system are
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introduced, and the embedded system development history is
overviewed. In Section III, goals and activities of this area are
observed in Latvian organizations. In Section IV, examples of
CPS application in different fields, including healthcare, are
given. In Section V, CPS design process features are
discussed. Section VI includes a brief summary and
conclusion.
II. CYBER-PHYSICAL SYSTEM OVERVIEW
Cyber-physical systems are developed to integrate real
physical processes and virtual computational processes. Many
objects used in a modern daily life are cyber-physical systems.
Concept of CPS is complicated, but it can be illustrated with a
concept map (see Fig. 1).
The definition of cyber-physical system from CyberPhysical Systems Week [1] is as follows: “Cyber-physical
systems (CPSs) are complex engineering systems that rely on
the integration of physical, computation, and communication
processes to function”.
Cyber-physical systems have not appeared from anywhere,
they have a long history of development, which continues.
This chapter is an introduction to cyber-physical systems, their
history and overview of the main components and
characteristics.
A. From Embedded Systems to Cyber-physical Systems
Always a growing need for different purpose information
management systems leads to the optimization of computing
tool design techniques. Most of the world’s currently used
information management systems are embedded systems and
networks. They are closely related to the control or
management objects.
From certain common computing system classifications, the
best suited to the modern situation is the classification
proposed by David Patterson and John Hennesy [2]. Their
classification was guided by the use of the system. They
divided computing system into 3 categories: desktop
computers, servers and embedded systems. Embedded systems
by the area of use are separated into:
• Automatic control systems;
• Measuring systems and systems that read information
from sensors;
• Real-time “question – answer” type information systems;
• Digital data transmission systems;
• Complex real-time systems;
• Moving objects management systems;
• A general purpose computer system subsystems;
• Multimedia systems.
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Fig. 1. A concept map of cyber-physical systems [3].
The concept of embedded systems appeared in the early 50s
and it is in rapid development even today. It is interesting to
view the evolution of embedded systems:
• Information management systems, 1960s;
• Embedded computing systems, 1970s;
• Embedded distributed systems, 1990s;
• Cyber-physical systems, since 2006.
Information management system is a computing system
designed for management purposes, but it is the most alienated
from the control object. Integrated micro-scheme and
microprocessor development led to information management
system bringing directly to the management object. The world
has entered the era of embedded systems. System elements are
gradually becoming cheaper and their integration increases, as
well as the security level and the opportunity to combine them
in controlled networks.
Downturn in embedded systems’ elements prices and
increasing connection with physical management objects led
to the appearance of cyber-physical systems.
Cyber-physical systems are specialized computing systems
that interact with control or management objects. Cyberphysical systems integrate computing, communication, data
storage with real world’s objects and physical processes. All
the above-mentioned processes must occur in real-time, in a
safe, secure and efficient manner. Cyber-physical systems
must be scalable, cost-effective and adaptive. Cyber-physical
systems are in use in various areas, such as smart medical
technologies, environmental monitoring and traffic
management.
Wireless sensor networks can become an important part of
cyber-physical systems, because of high sensitivity capability
that is one of the main driving factors of CPS application
distribution. The rapid development of WSN, medical sensors
and cloud computing systems makes cyber-physical systems
impressive candidates for use in inpatient and outpatient
health care improvement [4]. Cloud computing maturity is a
direct result of a few technologies, such as distributed
computing, internet technology, system management and
hardware development [5].
B. Concept of Cyber-physical Systems
Helen Gill, which at that time was the United States
National Science Foundation Director of the embedded and
hybrid systems sector, coined the term “cyber-physical
system” in 2006. The new term highlighted NSF CPS
Workshop originality. The seminar organizers sought to
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review the role of embedded systems, and they succeeded.
They saw the overall industry trend: after a few years cyberphysical system elaboration suddenly started in the world.
Many countries recognized CPS as a priority research
direction.
Cyber-physical systems integrate computing and physical
processes. Compared with embedded systems, much more
physical components are involved in CPSs. In embedded
systems, the key focus is on the computing element, but in
cyber-physical systems, it is on the link between
computational and physical elements. Cyber-physical system
parts exchange information with each other that is why the
third component – communication (see Fig. 2) is added there.
For this reason, cyber-physical system is denoted by the
symbol C3 (Computation, Communication and Control).
Link improvement between computational and physical
elements extends CPS usage possibilities.
• Electronics and Computer Science Institute: signal
processing, intelligent embedded systems and their networks,
testing and profiling environments;
• University of Latvia: different types of software for CFS;
• Riga Technical University: robotics and artificial
intelligence, electrical and optical systems;
• Latvian University of Agriculture: biological principlebased computer-controlled systems;
• Ventspils University: smart sensor systems;
• Transport and Telecommunication Institute: smart
transport systems.
These institutions do not compete among themselves but
complement each other with different aspects. Together they
fail to cover all the challenges in this field of research.
IV. CYBER-PHYSICAL SYSTEM APPLICATION
Cyber-physical systems are used in multiple areas, such as
medicine, traffic management and security, automotive
engineering, industrial and process control, energy saving,
ecological monitoring and management, avionics and space
equipment, industrial robots, technical infrastructure
management, distributed robotic systems, protection target
systems, nanotechnology and biological systems technology.
A. Smart Technologies
Fig. 2. Three main components of cyber-physical system [6].
III. SITUATION IN LATVIA
One of the main National Research Program aims in the
period of 2014–2017 is: “to develop the scientific expertise of
the next generation of ICT systems, creating a new
competitive approach to the physical and virtual world
integration cyber-physical systems, the development of
competitive smart sensor networks and innovative hardware
and software platforms, exploring and further developing
competitive models based on the new information and
communication technologies and their use in today’s
environment”.
In the discussion within the Working Group of Smart
Specialization Strategies, Modris Greitans (Director of the
Electronics and Computer Science Institute) expressed the
view that cyber-physical system is a large area and Latvia, as a
small country, cannot overlay all aspects; however, certain
aspects of this field have been studied and implemented in
several institutions in Latvia with a certain specialization.
Below, Latvian organizations are listed that develop cyberphysical systems:
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Modern construction technology enables the creation of
intelligent building designed with minimum energy
consumption or even without it. However, they need constant
monitoring. Engineers must attach smart buildings to smart
grids, and add control mechanism – cyber-physical
systems [7].
Smart transport is equipped with various types of
computerized embedded control systems. Cyber-physical
solution use in this field makes it possible to create a fullfledged single system that will link the vehicles with other
vehicles, environment and infrastructure [8]. An example of
cyber-physical systems known to the general public is Google
car, which does not require a driver.
B. Internet of Things and Industry 4.0
In several sources [5], [9], [10] it is predicted that within ten
years almost half of the electronic devices will be connected to
the World Wide Web. This network is termed as the Internet
of Things. It connects not only household appliances such as
refrigerators, thermostats, but also sophisticated production
equipment.
Industry 4.0 concept aims at the comprehensive cyberphysical system use in manufacturing, customer relationship
management and supply chain management processes,
combining it all into one system. Smart manufacturing lines
communicate with each other in order to optimize the
production process.
Comprehensive use of cyber-physical systems for
commerce, industry and public health, military and civilian
purposes, makes the protection of these systems a matter of
national significance. That is why embedded system security
systems, mainly anomaly detection system that allows
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resisting spoofing and service failure type attacks, are
currently actively developed [11].
C. Healthcare Cyber-physical Systems
There are hospitals, where robots already bring dishes to
patients, sort mail, change bed linen and collect waste.
Robotic beds transport patients to the surgery room. However,
a fully automated healthcare system has not been implemented
yet. Currently, a number of hospitals in the world remote
operations are carried out with the help of a robotic hand and
high-resolution cameras [12]; however, there is still a long
way to autonomous surgery when a cyber-physical system
itself, without human management, performs the operation.
(privacy, encryption), control/actuation (decision-making,
mechanism).
Existing healthcare cyber-physical systems were mapped to
this taxonomy, and a number of healthcare CPS groups (with
several examples) were allocated: notable CPS applications
(Electronic Medical Records, Medical CPS and Big Data
Platform, Smart Checklist), daily living applications (LiveNet,
Fall-Detecting System, HipGuard), medical status monitoring
applications (MobiHealth, CodeBlue, AlarmNet), medication
intake applications (iCabiNET, iPackage.).
Using this taxonomy and mapping, different cyber-physical
systems can be categorized. In addition, it is quite convenient
to use this taxonomy for formulation of new cyber-physical
system requirements.
V. DESIGN PROCESS
Patient
Actuators
Sensors
Control
Fig. 3. An example of healthcare cyber-physical system.
Human-in-the-loop cyber-physical systems can greatly
improve lives of people with special needs. Human-in-theloop cyber-physical systems formulate opinions about the
user’s intentions based on his cognitive performance by
analyzing data from sensors attached to the body or head.
Embedded system converts these findings to robot control
signals, which, thanks to robotic management mechanisms,
allow users to interact with the surrounding natural
environment. Example of human-in-the-loop CPS is robotic
assistance systems and intelligent prosthesis [13].
From the examples above, it is clear that the cyber-physical
systems are widely used all over the world in various
industries, including medicine and healthcare. However, only
one research was found [14], which summarizes the current
situation related to the CPS application in healthcare, and it
offers a detailed taxonomy.
Healthcare cyber-physical systems were categorized by
application (assisted, controlled), architecture (infrastructure,
data requirement, composition system), sensing (sensor type,
method, parameter), data management (data integration, data
storage,
data
processing),
computation
(modeling,
monitoring), communication (scheduling, protocol), security
Cyber-physical system, as well as any embedded system
design process includes requirements management and project
management, as well as test and safety plan. However, cyberphysical system development process is not possible without
the involvement of a different sector professional. CPS
development requires the knowledge of computers, software,
networks, and physical processes, which will be integrated
into the system.
Real-time operating systems manage embedded systems.
There software correctness is associated not only with the
correct ending, but also, for a certain task implementation
compliance of spent time with the planned time. It is quite
difficult to transfer these properties to the cyber-physical
systems. Different types of processors and memory
architectures, as well as a variety of operation systems and
programming environments are used in CPSs.
The development of cyber-physical systems, which closely
interact with physical processes, requires a technically
sophisticated low-level design. CPS developers are forced to
fight with break controllers, memory architecture, processes
planning, assembler level programming, network interface
design and installation of drivers. However, it would be better
to focus on system functionality and behavior definition.
The great complexity is not determinate due to the real
environment, in which the cyber-physical system is used.
Cyber-physical system may change by the time and no one of
the system’s component is completely safe.
All the above-described deviations from the final task
solving encouraged looking for new approaches to cyberphysical system design. Experts from the University of
Berkeley [15] believe that cyber-physical system’s design
should be based on the common system behavior modeling
and hardware, software, network and physical process single
design.
CPS design process is an iterative process, which consists
of three phases: modeling, design and analysis (see Fig. 4). In
order to develop systems, which are able to work in the real
world, a new approach – model designing is used.
Firstly, the real world analysis should be performed, and
physical processes identified, which will interact with cyberphysical system. Then it is possible to start development of an
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abstraction of the real world processes. Model design allows
overcoming some of the fundamental problems in the cyberphysical system design, such as security, determinism and
time.
Every system is designed to address a specific problem or
complete a task. System requirements can be described in a
simple language, in formal way or with models. The formal
description reduces the number of possible errors, but
modeling serves to illustrate the system dynamics.
Modeling
Design
Analysis
Fig. 4. Cyber-physical system design process.
During the process of analysis, the extent to which the
system has met the requirements specification can be
determined. CPSs are either commissioned or altered in
accordance with the previous and the new requirements. New
desires, needs and requirements to a cyber-physical system
will also arise in the use process.
In real conditions, for the research purposes only a verified
and validated cyber-physical system that successfully passed
safety tests must be used. It also applies to the new version of
the system or a supplement. Nevertheless, in healthcare
facilities only certified cyber-physical systems must be in use.
A set of regulations and standards is applied to all medical
systems, which indicates that the system is electrically,
physically, biologically and chemically safe for the end user.
Cyber-physical system sensors generate the sensitive data that
must be protected and shared only in a secure manner.
Currently, there are no standards and regulations, which relate
directly to healthcare cyber-physical systems [8], [14].
However, it is worthwhile to be acquainted with medical
equipment standards, regulations and clinical standards.
According to the European Union Glossary of Terms [16]:
• Standard is national or international level detailed
engineering characteristics that determine the optimal
requirements – performance, safety and reliability.
• Regulation is a set of rules with the force of law issued
by the executive authority.
As shown, the regulations are mandatory, while standards –
desirable. Although the regulations of medical equipment are
similar in several countries, they are not identical. This means
that the same medical device can be recognized as safe for use
in medical institutions of the European Union, but not in the
United States.
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The CE marking certifies that a product has been approved
for use and distribution in Europe – a direct translation of the
French term “Conformité Europen” or “Approved in Europe”.
By contrast, in the United States U.S. FDA (United States
Food and Drug Administration) shall indicate the medical
equipment compliance with their regulations. Countries,
which have not developed or adopted any medical equipment
regulations primarily, apply the WHO (World Health
Organization) regulations.
While standards of healthcare cyber-physical systems are
not yet developed, a number of industrial, communications
(for example, Bluetooth – IEEE 802.15.1, Wi-Fi – IEEE
802.11), quality (ISO 9001, ISO 13845, ISO 14971), medical
equipment (ISO/IEEE 11073, HL7 – Health Level 7,
DICOM – Digital Imaging and Communications in Medicine)
and clinical standards can be applied to them.
ISO/IEEE 11073 is a standard set for personal healthcare
devices. The general context of it is data communication and
interface between the agent and the manager.
Health Level 7 is a group of standards for the exchange,
integration, sharing, and retrieval of electronic health
information. HL7 determines many adaptable standards,
guidelines, and methodologies that enable communication of
various computer systems in hospitals and different healthcare
providers.
Generalizing, medical equipment standards have been
drawn up to improve the quality and number of facilities, and
equipment interoperability.
VI. CONCLUSION
Healthcare cyber-physical systems can reach the level of
functionality, adaptability, and effectiveness previously
unattainable for medical devices.
During the first part of research, the authors reviewed
healthcare cyber-physical system application and compliance
with existing standards and possibilities for further system
development.
After identification of main tasks of the healthcare cyberphysical system and looking at the above-mentioned
regulations and standards, a requirement definition can be
initiated so that the CPSs comply with appropriate regulations
and standards.
ACKNOWLEDGEMENT
This research has been supported by the Latvian state
research program 2014–2017 project “The Next Generation of
Information and Communication Technologies (NexIT)”.
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Eiropas Savienības terminu vārdnīca. – R., UNDP, 2004.
She received the Bachelor Degree in Information Technology from Riga
Technical University in 2012. Her Bachelor Thesis on SCADA network
security received special support from the Latvian local energy production
company and was among laureates of the best Latvian theses in the field of
Information Technology in 2012. She has experience in software
development, and currently she is a Project Manager at an international
company. Her professional interests include project management, software
and systems, particularly healthcare systems, design, modeling and
development. She has participated in a number of international scientific
conferences and multiple projects.
E-mail: [email protected].
Andrejs Romanovs, Dr. sc. ing., is an Associate Professor and Lead
Researcher at the Information Technology Institute, Riga Technical
University. He has 25 years of professional experience teaching post-graduate
courses at RTU and developing more than 50 industrial and management
information systems. His professional interests include modeling and design
of management information systems, IT governance, IT security and risk
management, integrated information technologies, as well as education in
these areas. A. Romanovs is a senior member of the IEEE, LSS; the author of
more than 50 papers in scientific journals and conference proceedings in the
field of Information Technology.
E-mail: [email protected],
Nadezhda Kunicina, Dr. sc. ing. Since 2005 she has been an Associate
Professor with RTU. Her fields of scientific interest are electrical engineering,
embedded systems, sustainable transport systems. The research interest is
related to the improvement of electric energy effectiveness in industrial
electronics and electric transport. She is a Scientific Project Manager of FP7 –
ARTEMIS – 2012 called Arrowhead project. The aim of project is to address
the technical and applicative challenges associated with cooperative
automation.
E-mail: [email protected].
Alyona Skorobogatjko, B. sc. ing., is a Master’s Student at the Department
of Information Technology Management, Riga Technical University (Latvia).
Aļona Skorobogatjko, Andrejs Romanovs, Nadežda Kunicina. Veselības aizsardzības kiberfizikālo sistēmu apskats
Jau vairākus gadus dažādu nozaru speciālisti visā pasaulē interesējas par virtuālās un fiziskās pasaules mijiedarbības iespēju izmantošanu. Kiberfizikālo sistēmu
pielietošanas mērķis ir integrēt reālus fiziskus procesus ar virtuāliem skaitļošanas procesiem. Pētījuma tēmas aktualitāte ir neapšaubāma un balstās uz to, ka
kiberfizikālās sistēmas ir daudzsološa joma, kuras attīstība virza uz priekšu medicīnu. Kiberfizikālās sistēmas ir specializētas skaitļošanas sistēmas, kurām ir
fiziskas mijiedarbības līdzekļi ar kontroles un vadības objektu. Iegultās sistēmās galvenais fokuss ir skaitļošanas elements, bet kiberfizikālās sistēmās – saite
starp skaitļošanas un fizisko elementu. Kibefizikālās sistēmas tiek pielietotas tādās jomās kā medicīna, transporta plūsmu vadība, automobiļu būvniecība,
industriālo un tehnoloģisko procesu vadība, enerģijas ekonomija, ekoloģijas monitorings un pārvaldība, avionika un kosmiskā tehnika, industriālie roboti,
tehniskās infrastruktūras pārvaldība, sadalītas robottehnikās sistēmas, sistēmas aizsardzības mērķiem. Ir slimnīcas, kur jau tagad roboti pienes pacientiem ēdienu,
šķiro pastu, maina gultasveļu, kā arī transportē pacientus uz operāciju zāli ar robotizētām gultām. Taču pilnībā automatizēta veselības aizsardzības sistēma vēl
nevienā medicīnas iestādē nav ieviesta. Kiberfizikālo sistēmu izstrādei ir nepieciešamas gan zināšanas par datoriem, programmatūru, tīkliem, gan arī par
fiziskiem procesiem, ar kuriem tiks integrēta izstrādājamā sistēma. Kiberfizikālo sistēmu izstrāde ir iteratīvs process, kas sastāv no 3 fāzēm: modelēšanas,
izstrādes un analīzes. Pirms veselības aizsardzības kiberfizikālās sistēmas izstrādes ir vērts iepazīties ar medicīnas iekārtu standartiem un nolikumiem, kā arī
klīnisko pētījumu standartiem, kurus apskatot un, identificējot izstrādājamās sistēmas galvenos uzdevumus, var uzsākt prasību definēšanu atbilstoši attiecīgajiem
nolikumiem un standartiem.
Алёна Скоробогатько, Андрей Романов, Надежда Куницына. Современное состояние медицинских кибер-физических систем
На протяжении последних десятилетий специалисты из разных областей заинтересованы в исследовании возможностей взаимодействия реального
мира с виртуальным. Кибер-физические системы – это специализированные вычислительные системы, которые включают в себя объекты
взаимодействия с реальным миром, вычислительные объекты и систему коммуникации. Тема исследования весьма актуальна, так как киберфизические системы являются многообещающей отраслью, развитие которой способствует развитию медицины в целом. Во встроенных системах
главной является вычислительная часть, а в кибер-физических системах – связь между вычислительными и физическими элементами. В современном
мире кибер-физические системы используются в медицине, в том числе в телемедицине, управлении транспортом и обеспечении безопасности,
автомобилестроении, в распределённых роботизированных системах, управлении производственными и технологическими процессами. Существуют
больницы, в которых уже сейчас роботы разносят еду пациентам, меняют постельное бельё, с помощью роботизированной кровати пациенты
транспортируются в операционные залы, но полностью автоматизированная система здравоохранения ещё не введена ни в одном медицинском
учреждении. Разработка кибер-физических систем невозможна без знаний о вычислительных системах, сетях, но ещё более важными являются знания
о физических процессах, интегрируемых с виртуальными процессами. Процесс разработки кибер-физических систем является итеративным
процессом и состоит из трех фаз: моделирования, разработки и анализа. На данный момент не существует стандартов и регламентов, относящихся
именно к медицинским кибер-физическим системам, поэтому стоит ознакомиться со стандартами и регламентами разработки медицинских систем, а
также со стандартами клинических исследований. Рассмотрев вышеупомянутые регламенты и стандарты и определив главные задачи
разрабатываемой системы, можно начать процесс формулирования требований к медицинской кибер-физической системе.
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Download Date | 6/17/17 4:09 AM
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